番茄社区

PHILADELPHIA -- Postpartum blood pressure was improved following a hypertensive pregnancy with a self-managed, physician-guided telemonitoring program, the randomized POP-HT trial revealed.

The intervention lowered mean 24-hour ambulatory blood pressure by 6.5/5.8 mm Hg compared with usual care at 9 months postpartum (both P<0.001), reported Jamie Kitt, DPhil, of the University of Oxford in England, in a late-breaking clinical trial session at the American Heart Association (AHA) annual meeting. The results were simultaneously published in .

The intervention, which included daily home blood pressure monitoring data uploaded via a smartphone app and treatment adjustment based on those results, also reduced postnatal readmissions for elevated blood pressure (8 versus 29 cases, P<0.001).

These findings counter assumptions that there isn't much clinicians can do about blood pressure during and after pregnancy, co-author Paul Leeson, PhD, also of the University of Oxford, told 番茄社区.

"By actually doing something positive during this early period, you can have a long-term benefit," Leeson said. That's particularly important as some 10% of pregnancies involve maternal blood pressure complications.

"It's become increasingly known that women who have hypertension and pregnancy are at risk of later complications. So whatever we can do to reduce those complications is also a big deal," said Sandra Taler, MD, of the Mayo Clinic in Rochester, Minnesota, and moderator of an AHA press conference where the findings were discussed.

Angela Burgess, MD, a maternal-fetal medicine physician with the University of Texas Health Science Center at Houston, told 番茄社区 that the most striking finding was that the intervention group had lower blood pressure "despite most participants no longer taking antihypertensive treatment." Medication persistence at 6 weeks was about 30% in each group, which dropped to about 12% by the office visit at 6 to 9 months postpartum.

Burgess called the findings evidence that "having continued close follow-up, utilizing self-monitoring, and advancing technology can lead to overall better patient outcomes."

The POP-HT trial was a single center, open-label, blinded endpoint study. It included 220 pregnant patients age 18 or older (mean 32.6) with gestational hypertension (40%) or preeclampsia (60%) that required antihypertensive medication postnatally at discharge. Participants were randomized 1:1 to either receive standard care or the self-managed intervention.

The self-managment group took their own blood pressure measurements daily, or twice daily if abnormal. They were taught to use a wireless, Bluetooth-enabled Omron Evolv upper arm blood pressure cuff and a smartphone app. The app uploaded measurements and provided notifications to down-titrate medication, continue current dosing, or to up-titrate dosing under the advice of a research study clinician.

The control group received standard of care, which was generally blood pressure review at 7 to 10 days postpartum and a doctor visit at 6 to 8 weeks. All participants had four follow-up postpartum visits.

Participants were enrolled starting on Feb. 21, 2020, with the last follow-up on Nov. 2, 2021. The primary outcome was the 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure.

Authors noted that limitations of the study included the unblinded and single-center nature of the trial, the fact that most patients were white, that the required use of technology could have ruled out older and poorer participants, as well as the onset of the COVID-19 pandemic, which changed home blood pressure monitoring guidance.

In the future, Burgess said she would like to see results of such an intervention among a more diverse group and among women with higher blood pressure. Leeson also said he'd like future research to look into how to implement the intervention as well as using similar techniques for other kinds of monitoring.

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